Individual provider Active NPI

Yongwoo Lim, DDS

  • Dentist
  • Tucson, AZ
National Provider Identifier
1861389157
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D012575 Issued in AZ
Practice address
1060 S Harrison Rd Ste 110
Tucson, AZ 85748-6603
Phone
(520) 917-0666
NPI assigned
Jun 20, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D012575 AZ Primary

Addresses

Primary practice location

1060 S Harrison Rd Ste 110
Tucson, AZ 85748-6603

Mailing address

9125 E Catalina Hwy Unit 178
Tucson, AZ 85749-6912

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251008000955 AZ Order and Referring Only - DentistPractitioner - Dentist 7012414956

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D012575AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Spanish Trail Dental Group, LLP General Practice CurrentSince Jun 23, 2025 Accepting new patients

Locations

1060 S Harrison Rd
Ste 110
Tucson, AZ 85748
Phone (520) 917-0666

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1861389157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9125 E CATALINA HWY UNIT 178",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857496912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 S HARRISON RD STE 110",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857486603",
            "telephone_number": "520-917-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "YONGWOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-20",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.